In this review, we discuss predisposing factors to transsexualism, and the diagnosis, assessment and hormone treatment of transsexual patients. We also discuss the risks and organ-specific effects of cross-sex hormone treatment. We will briefly summarize the current legal position of transsexuals in the UK and recommendations for the culturally competent delivery of transgender health careAnd in view of my latest anomalous blood tests - I failed them again - something of personal interest:
Risks - PituitaryMy prolactin levels, which had been increasing slowly and steadily since before I started HRT in a nice, smooth curve, suddenly went haywire in the last test. Which also showed at least double the expected result of E2 (oestrogen).
In a preliminary study of 142 male-to-female transsexuals treated with oestrogen and cyproterone for from 6 months to 9 years, variable increases in circulating prolactin but no specific risk of inducing autonomous prolactin secretion was found (Gooren et al., 1985). The same group reported a more extensive series of 214 oestrogen- and cyproterone-treated male-to-female transsexuals in which modest increases in prolactin were thought to be universal. In this population prolactin increased to over 1000 mU/l in 20% (Asscheman et al., 1988; 14% in the van Kesteren et al., 1997 series) and remained persistently elevated in 15 (7%). Of these, five (2%) were believed to show pituitary enlargement on computed tomographic (CT) scanning but again, prolactinoma development was not found (Asscheman et al., 1988).
Autonomous prolactin secretion in a 26-year-old male-to-female transsexual who in addition to the prescribed 100 µg oral ethinylestradiol daily surreptitiously injected herself with 100 mg oestradiol-17-undecanoate intramuscularly for at least 6 of the 10 months of treatment has been reported (Gooren et al., 1988), and a histologically proven prolactinoma reported in a 33-year-old male-to-female transsexual who had received exogenous oestrogen for the previous 17 years (Kovacs et al., 1994). Given the high frequency of occult prolactinoma formation (Molitch, 1997) and the apparent rarity of prolactinoma in genetic males during cross-sex hormone therapy, a direct link between exogenous oestrogens and prolactinoma induction in humans cannot be drawn. Contrary to early conclusions (Asscheman et al., 1988; Goh & Ratnam, 1990), safety data about adverse pituitary effects of oestrogens in genetic males are reassuring.
Cholesterol levels are down. "First Responder" white blood cells up - the kind that are the first symptom of both minor inflammation, and a neoplasm. So I'm now officially in uncharted territory once more. The increased oestrogen has had some quite beneficial effects though...it suits me.
Anyway, I'm reassured. It's still not as weird a situation as in 2005. Moving roght along...
The article details a number of different treatment regimes from various clinics around the world. There's still not a lot of data on optimising techniques for determining the right dosage. It appears that individual variability means we can't give a dose, just a technique for finding the right dose, and adjusting it as circumstances change.
There's a surprising degree of lack of knowledge in all areas of Medicine. The Healing Arts are well-named, as the Science is, well, spotty. As regards Transsexuality and Intersex, distinctly Dalmationesque.